The American Academy of Orthopaedic Surgeons (AAOS) board of directors recently approved at their Sept. 24 meeting a new clinical practice guideline on the treatment of osteoporotic spinal compression fractures. The guideline includes 11 recommendations, but only two of those recommendations carry any real weight, the board said.
Whereas the board found that for nine of the 11 recommendations the evidence was insufficient or conflicting and did not enable the workgroup to make a recommendation for or against the intervention, The Clinical Practice Guideline on the Treatment of Symptomatic Osteoporotic Compression Fractures includes one recommendation that is supported by moderately high-quality evidence and one strong recommendation supported by evidence that the workshop found both “overwhelming and compelling.”
The first recommendation based on moderately high-quality evidence suggests that patients who have radiographic evidence of an osteoporotic spinal compression fracture with correlating clinical signs and symptoms suggesting an acute injury (within five days of an identifiable event or onset of symptoms) and who are neurologically intact be treated with calcitonin for four weeks.
The single strong recommendation in the guideline is that for vertebroplasty (CPT® codes 22520-22522). “We recommend against vertebroplasty for patients who present with an osteoporotic spinal compression fracture on imaging with correlating clinical signs and symptoms and who are neurologically intact,” said the AAOS board of directors.
The guideline considers kyphoplasty (CPT® codes 22523-22525) to be an option (with a weak recommendation), however. “Although kyphoplasty and vertebroplasty are similar procedures, the evidence supports treating them differently within the recommendations,” said the board.
The guideline is available on the AAOS website.
October 15th, 2010